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One of the main problems with fluid in the ear is that there aren't any obvious symptoms.

Unlike an ear infection, fluid in the ear doesn't cause symptoms such as pain, fever or pus coming out of the ear.

Poor hearing is the most common symptom.¹ It happens because the fluid that is trapped in the middle ear surrounds the eardrum and the small bones. Because they can't move freely, they can't carry sound to the inner ear as well as they should.

Hearing loss is often easy to miss. But it's important to be aware of signs that a child cannot hear properly. You may notice that your child:^{1 2 3}

• Seems not to listen to you
• Has the television on at high volume
• Has problems hearing if he or she can't see the person speaking
• Doesn't pay attention
• Is overactive
• Asks, "What did you say?" more often
• Speaks more loudly, or talks less
• Says words incorrectly or speaks less clearly
• Falls behind friends in his or her use of new words and speech patterns.

Poor hearing can have other causes, but fluid in the ear is the most common form of hearing loss among children.² See your doctor if you think your child cannot hear properly.

It's hard to know exactly how much your child's hearing may be affected by fluid in the ear. It varies from child to child. Most children with fluid in the ear have what doctors call mild hearing loss. To learn more, see Hearing loss with fluid in the ear.

When the fluid in the ear clears up, your child's hearing will go back to normal.

If your child is having problems hearing because of fluid in the ear, there are things you can do to make sure he or she can hear you. To learn more, see How to make sure your child hears you.

A change in your child's behavior may be the first thing you or your child's caregiver or teacher notices. Not being able to hear properly can make your child feel cut off and frustrated. This is especially true if he or she is too young to tell you about the problem.

A child with fluid in the ear may be:⁴

• Restless
• Fidgety
• Often disobedient
• Unable to follow instructions at school
• Doing less well than expected at school
• Unable to concentrate for long
• Unable to get along with other children.

Of course, all young children have these sorts of problems from time to time. So you may find it hard to say whether your child's behavior is normal. Fluid in the ear is common at ages when children are growing rapidly and going through changes in mood and behavior anyway. But having fluid in the ear can make behavior problems worse.

In one study, more than half of pre-school children who'd had fluid in the ear for at least three months had problems with their behavior.⁴ These problems were much less common in children who didn't have fluid in the ear.

There are a few other things that you can look for. Older children (and adults too) may complain that their ears feel "blocked" or "plugged up." Some children with fluid in the ear may have a runny nose all the time. Occasionally, children with fluid in the ear have a mild earache. But earache is far more common with an ear infection. Fluid in the ear isn't an infection. The fluid that is trapped inside the ear doesn't usually contain germs.²

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.